# Hepatitis C Virus Cascade of Care After the Introduction of Direct-Acting Antiviral Medications in Suriname

## TL;DR

This study examines the HCV treatment process in Suriname after introducing DAAs, highlighting barriers and the potential of APRI as a non-invasive diagnostic tool.

## Contribution

The study evaluates the HCV care cascade and assesses APRI as an alternative to liver elastography in a low-resource setting.

## Key findings

- Only 45.3% of HCV patients completed treatment and outcome evaluation.
- APRI showed 75% sensitivity and 85.7% specificity for detecting cirrhosis.
- DAAs achieved a 100% sustained virological response in patients who completed treatment.

## Abstract

Introduction: Suriname has a hepatitis C virus (HCV) prevalence of 1%. In 2019, direct-acting antivirals (DAAs) were introduced. Treatment was started in HCV patients who could afford the procurement of DAAs, since no insurance policy covered treatment at that time. This study aims to identify barriers in our HCV treatment cascade and evaluate the aspartate aminotransferase-to-platelet ratio index (APRI) as a non-invasive test for detecting fibrosis and cirrhosis.

Materials and methods: We developed an HCV cascade of care for patients in the four general hospitals in the capital, spanning from linkage to care through to resolution of the infection. Furthermore, liver elastography is a crucial diagnostic tool for staging liver disease. Unfortunately, this is not widely available and can delay treatment initiation. Therefore, we evaluated the APRI as an alternative tool for staging liver disease.

Results: Of the 274 HCV patients, 216 (78.8%) could be linked to care, 174 (63.9%) were eligible for treatment, 156 (57.3%) started treatment, of which 149 (54.7%) completed it. Ultimately, 123 (45.3%) individuals attended their outcome evaluation, all of whom had achieved a sustained virological response 12 weeks after treatment completion. For detecting cirrhosis, an APRI value > 1.0 had a sensitivity and specificity of 75% and 85.7%, respectively. For detecting fibrosis or cirrhosis, an APRI value > 0.7 had a sensitivity and specificity of 69.2% and 61.4%, respectively.

Conclusions: Although treatment with DAAs in Suriname is highly efficacious, several hurdles, including improving linkage and access to treatment, must be addressed to reduce the disease burden of HCV in Suriname successfully.